New Visit

patient

Patient Name:

Phone number:

PD of patient:

visits:

Date of visit:: 10/4/2025 2:04:00 PM
Cost:: 90
Service:: Frame + Lenses
prescribed by doctor:: luna
Notes:: Antiblue Transition

	SPH	CYL	AX	ADD
OD	-0.5	-0.25	177
OS	-0.25	-0.75	180

New visit Information

Date of visit:

Cost in this visit:

type of service:

prescribed by doctor

Note:

	SPH	CYL	AX	ADD
OD
OS